Provider Demographics
NPI:1427277714
Name:WERTHEIM, RAYMOND B (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:B
Last Name:WERTHEIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-549 PLUMERIA ST
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-6902
Mailing Address - Country:US
Mailing Address - Phone:808-775-7204
Mailing Address - Fax:808-775-9404
Practice Address - Street 1:45-549 PLUMERIA ST
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-6902
Practice Address - Country:US
Practice Address - Phone:808-775-7204
Practice Address - Fax:703-683-5638
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD81152084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA50106Medicare UPIN